Contralateral supraorbital approach

The resection of tuberculum sellae meningiomas poses a challenge particularly when dealing with the medial aspect of the optic nerve. Dissection of the tumor off the optic nerve is usually carried out in the blind spot “behind” the optic nerve.

Peto et al. described a contralateral approach for asymmetric tuberculum sellae meningiomas, allowing direct visualization of the medial optic nerve.

Contralateral lateral supraorbital approach was performed, and complete tumor resection was achieved without any injury to the optic nerve.

The contralateral approach for asymmetric tuberculum sellae meningioma is an efficient technique allowing improved visualization of the medial optic nerve 1).

In 2017 Singh et al. described the supraorbital keyhole approach to the contralateral medial optic nerve and tract, both in a series of cadaveric dissections and in 2 patients. They also discussed the indications and contraindications for this procedure.

In 3 cadaver heads, bilateral supraorbital keyhole minicraniotomies were performed to expose the ipsilateral and contralateral optic nerves. The extent of exposure of the medial optic nerve was assessed. In 2 patients, a contralateral supraorbital keyhole approach was used to remove pathology of the contralateral medial optic nerve and tract. RESULTS The supraorbital keyhole craniotomy provided better exposure of the contralateral superomedial nerve than it did of the same portion of the ipsilateral nerve. In both patients gross-total resections of the pathology was achieved. CONCLUSIONS The authors demonstrate the suitability of the contralateral supraorbital keyhole approach for lesions involving the superomedial optic nerve 2).

Peto I, White TG, Dehdashti AR. How I do it: contralateral supraorbital approach for tuberculum sellae meningioma. Acta Neurochir (Wien). 2020 Jan 3. doi: 10.1007/s00701-019-04205-8. [Epub ahead of print] PubMed PMID: 31900657.
Singh H, Essayed WI, Jada A, Moussazadeh N, Dhandapani S, Rote S, Schwartz TH. Contralateral supraorbital keyhole approach to medial optic nerve lesions: an anatomoclinical study. J Neurosurg. 2017 Mar;126(3):940-944. doi: 10.3171/2016.3.JNS1634. Epub 2016 Jun 3. PubMed PMID: 27257841.
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